Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial.
Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial.
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DOI：
10.1016/s0140-6736(13)60852-1
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发表时间：
2013-08-10
期刊：
影响因子：
168.9
通讯作者：
Mayo, M.
中科院分区：
文献类型：
--
作者：
Benavente, O. R.;Coffey, C. S.;Conwit, R.;Hart, R. G.;McClure, L. A.;Pearce, L. A.;Pergola, P. E.;Szychowski, J. M.;Benavente, O. R.;Hart, R. G.;Pergola, P. E.;Palacio, S.;Castro, I.;Farias, A.;Roldan, A.;Kase, C.;Gavras, I.;Lau, H.;Ogrodnik, M.;Allen, N.;Meissner, I.;Graves, J.;Herzig, D.;Covalt, J.;Meyer, B.;Jackson, C.;Gamble, P.;Kelly, N.;Warner, J.;Bell, J.;Demaerschalk, B.;Hogan, M.;Wochos, D.;Wieser, J.;Cleary, B.;Wood, L.;Hanna, J.;Zipp, T.;Bailey, S.;Cook, D.;Liskay, A.;Simcox, D.;Kappler, J.;Anderson, D.;Grimm, R.;Brauer, D.;Pettigrew, C.;Vaishnov, A.;Sawaya, P.;Fowler, A.;Hughes, N.;Rice, J.;Vanderpool, K.;Cruz-Flores, S.;Walden, H. D.;Holzemer, E.;Santhakumar, S.;Van Stavern, R.;Chatuverdi, S.;Flack, J.;Mada, F.;Wiseman, D.;Berlow, E.;Klinker, J.;Chiu, D.;Taylor, A.;Katz, L.;Coull, B.;Howard, L.;Malekniazi, M.;VanSkiver, M.;Bruck, D.;Redman, S.;Logan, W.;Carpenter, D.;Schroer, S.;Katramados, A.;Silver, B.;Yee, J.;Aiello, K.;Wilson, K.;McCarthy, S.;Dandapani, B.;Spies, C. P.;Vasile, C.;Anthony, B.;Ferguson, J.;Krubel, S.;Synman, A.;Andrews, N.;Kirshner, H.;Sussman, C.;Brown, D.;Elkind, M.;Crew, R. J.;Radhakrishan, J.;Corporan, T. E.;Diaz, J.;Aragon, R.;Slivka, A.;Spetie, Dan;Agriesti, J.;Notstein, P.;Naritoku, D.;Zweifler, R.;Culpepper, M.;Parnell, M.;Yunker, R.;Boots, K.;Drinkard, R.;Backlin, R.;Benesch, C.;Bisognano, J.;Leonhardt, A.;Zentner, J.;Hildreth, M.;Johnson, M.;Liu, Y.;Goldsteen, R.;Blair, A.;Wright, G.;Gathua, N.;Book, D.;Eapen, S.;Grimm, C.;Blaney, B.;Rozman, S.;Gaertner, L.;Bradenburg, E.;Loomis, L.;Monarch-Cotton, J.;Ravavelli-Meyer, J.;Golembieski, A.;Burgin, S. W.;Hollander, J.;Polashenski, W.;Wallace, P.;Weber, C.;Lutsep, H.;Girard, D.;Seisler, K.;Cingel, M.;Ross, M.;Stone, R.;Larsen, D.;Doherty, A.;David, L.;Levy, P.;Buchheimer, N.;Vaughn, S.;Smith, E.;Satterfield, J.;Tirschwell, D.;Logar, C.;Ryan, M.;Schubert, G.;Tanzai, P.;Mirsen, T.;McAllister, S.;Bastien, A.;Niblack, P.;Frey, J.;Darbonne, C.;Karanjia, P.;Murali, N.;Dart, R.;Mancl, K.;Atkinson, R.;Lieberman, R.;Carter, T.;Zrelak, P.;Kenney, N.;Jacoby, M.;Jones, D.;DeFrancisco, J.;Hamm, T.;Romano, J.;Ortiz, G.;Lichtenberger, M. del Carmen;Linas, R.;Kravet, S.;Alt, J.;Sundararajan, S.;Rahman, M.;Horvath, T.;Korosec, D.;Murphy, C.;Greenberg, J.;Lennihan, L.;King, M.;Tenteromano, L.;Frankel, M.;Doyle, J.;Braimah, J.;Pereira, L.;Ching, M.;Sawyer, R.;Parkes, K.;Conover, C.;Albakri, E.;Ramirez, G.;Segal, S.;Taylor, K.;Jackson, J.;Helgason, K.;Hillmann, M.;Ringel, R.;Fleming, N.;Mckown, B.;Cohen, S.;Jenders, R.;Singh, R.;La, M-T;Trinh, K.;Weinberger, J.;Wright, L.;Burch, D.;Horowitz, R.;Atlas, S.;Augustine, S.;Van Stavern, R.;Brown, A.;Serna, J.;Newgent, J.;Naylor, J.;Carpenter, L.;Warwick, T.;Stoltz, S.;Garcia, R.;Scheck, M.;Chadwick, L.;Fleck, J.;Weinberger, M.;Sears, A.;Fanale, C.;Neeper, L.;Fisk, P.;Cohen, S.;Sabry, D.;Phoenix, R.;Tong, D.;Garcia, M.;Mackey, A.;Morin, J.;Hache, A.;Lessard, C.;Cote, R.;Green, L.;Wadup, L.;Fontaine, A-M;Gubitz, G.;Rebello, R.;Dean, T.;Reidy, Y.;Sharma, M.;Stotts, G.;Clark, H.;Mortensen, M.;Sauve, J.;Sharma, D.;Savage, M.;Minuk, J.;Trudeau, L.;Schanz, C.;Berger, L.;Brunet, S.;Pontbriand, J.;Mainville, M.;Racicot, D.;Hill, M.;Fischer, K.;Cole-Kaskayne, A.;Keeney, C.;Shuab, A.;Khan, K.;Dean, N.;Herbert, F.;Kastelic, K.;Pretell, E. J.;Valdivia, J.;Pretell, M.;del Brutto, O.;Santibanez, R.;Lara, J.;Zambrano, M.;Arauz, A.;Cervantes, G. A.;Leyva, A.;Camacho, I.;Sandoval, J. L. Ruiz;Vasquez, E. Salcido;Ruiz, C.;Brito, C. Cantu;Fernandez, M.;Gongora-Rivera, J. F.;Escamilla, J. M.;Moxica, J.;Arciniega, G.;Gonzalez, W. J.;Matamala, G.;Goecke, H.;Parra, M.;Pozo, J.;Tapia, J.;Godoy, I. E.;Valdes, M.;Estol, C.;Peralta, C.;Ellenberg, A.;Chezzio, D.;Pardal, M. M. Fernandez;Trimachi, H.;Bonardo, P.;Mazziotti, J.;Rey, R. C.;Caruso, G.;Melamud, L.;Lepera, S.;Stilman, A. P.;Ameriso, S.;Sanchez, R.;Bruera, G.;Moschini, J.;Ramirez, M. J.;Bueri, J. A.;Sevilla, S.;de Ambrosi, B.;Marinsalta, G.;Rubio, F.;Krupinski, Y.;Carvajal, A.;Roquer, J.;Serrano, A. Oliveras;Conde, J. Jimenez;Rodriguez, A.;Romeral, G.;Arboix, A.;Pelegri, A.;Blanco, L.;Verge, D. Canovas;Herrero, J. Estela;Gomez, A.;Blanco, L.;Leal, J. S.;Castellanos, M.;Cruz, V.;Cepeda, M.;Gomis, M.;Arenillas, J.;Davalos, A.;Sunol, A.;Reverte, S.;Lluis, J.;Sergio, M. V.;Marin, M. R.;Sanchez, J. Castillo;Blanco, M.;Rodriguez, G. Manuel;Jimenez, I.;Rodriguez, J.;Tejedor, E. Diez;Martinez, P.;Fuentes, B.;Singla, L. Soler;Balaguer, E.;Izquierdo, J.;Soler, C.;Armenteros, M.;Benavente, O. R.;Hart, R. G.;Pergola, P. E.;Shepherd, A.;Roldan, A.;Benavente, M-F;White, C.;Robu, C.;Kelly, C.;Talbert, R.;Martinez, E.;Bazan, C.;Pergola, G.;Pearce, L. A.;Costello, R.;Jacova, C.;Camelia, L.;Mendoza, C.;Pratt, B.;Kin, B.;Holliday, S.;McClure, L. A.;Coffey, C.;Szychowski, M.;Howard, G.;Katholi, C.;Zhang, Yu;Peri, K.;Allcorn, C.;Mailhot, R.;Irby, L.;Guyton, F.;Sewell, M. J.;Ringer, R.;Raisch, D.;Hunt, D.;Rubio, F.;Rosso, C. M.;Martin, A.;Sanllorente, M.;Arabetti, C.;Fernandez, J. Luis;Cremona, M. J.;Capece, A.;Benavente, O. R.;Hart, R. G.;Benavente, M-F;Coffey, C.;Conwit, R.;McClure, L. A.;Pergola, P. E.;Roldan, A.;Szychowski, J. M.;Talbert, R.;Benavente, O. R.;Anderson, D.;Arauz, A.;Benavente, M-F;Coffey, C.;Conwit, R.;Cote, R.;Demaerschalk, B.;del Brutto, O.;Elkind, M.;Hart, R. G.;Kase, C.;McClure, L. A.;Moy, C.;Pergola, P. E.;Roldan, A.;Sharma, M.;Szychowski, J. M.;Talbert, R.;White, C.;White, C.;Benavente, O. R.;Benesch, C.;Coffey, C.;Conwit, R.;Graves, J.;Grimm, R.;Gubitz, G.;Holliday, S.;Lau, H.;Moy, C.;Pearce, L. A.;Szychowski, J. M.;Aguilar, M.;Sherman, D.;Nasco, E.;Blackshear, J.;Chung, M.;Fayad, P.;Gage, B.;Johnston, C.;Kernan, W.;Leira, E.;Merino, J.;Roman, G.;Sila, C.;Sung, G.;van Walraven, C.;Zweifler, R.;Stern, B.;Conwit, R.;Moy, C.;Welch, K. M.;Clarke, W.;Cutler, J.;Furie, K.;Johnston, K.;Mayo, M.
降低血压（BP）可以预防中风，但目前还缺乏预防中风复发的最佳降血目标水平。我们假设收缩压<130 mmHg可以减少近期腔隙性卒中患者的卒中复发。小皮质下卒中的二级预防（SPS3）是一项多中心国际试验，涉及3020例近期有症状的mri定义的腔隙性梗死患者，随机分为两个收缩压目标水平：a)高组130 - 149 mm Hg和b)低组<130 mm Hg，平均随访3.7年。主要结局是所有复发性卒中（包括缺血性卒中和颅内出血）。该研究已注册，编号为NCT 00059306。参与者平均年龄63岁；1年后，高组的平均收缩压为138 mm Hg (95% CI为137 ~ 139)，低组的平均收缩压为127 mm Hg （95% CI为126 ~ 128）。在最后一次研究访问时，两组之间的收缩压差平均为11 mm Hg（±SD 16）。高目标组脑卒中年化复发率为2.77% (n=152)，低目标组为2.25% (n=125) （HR 0.81, 95% CI 0.64, 1.03， p值0.08）。致残/致死性卒中的减少也有类似的趋势（HR 0.81, 95%CI 0.53, 1.23， p值0.32），卒中、心肌梗死或血管性死亡的复合结局（HR 0.84, 95%CI 0.68,1.01， p值0.10）。低目标组的脑出血减少了63% （HR 0.37 95% CI, 0.14, 0.89， p值0.03）。严重降压并发症发生率较高，组间差异无统计学意义。在近期腔隙性卒中患者中，以收缩压< 130 mm Hg为目标并不能显著减少所有卒中，但能显著减少脑出血。较低的目标是安全且耐受性良好的。
Lowering blood pressure (BP) prevents stroke, however optimal target levels of blood reduction to prevent stroke recurrence are lacking. We hypothesized that targeting systolic BP of <130 mmHg would reduce stroke recurrence in patients with recent lacunar stroke. The Secondary Prevention of Small Subcortical Strokes (SPS3) was a multi-center international trial, involving 3020 patients with recent symptomatic MRI-defined lacunar infarcts randomized to two target levels of systolic BP: a) higher group 130–149 mm Hg vs. b) lower group <130 mm Hg, and followed for a mean of 3.7 years. The primary outcome was all recurrent stroke (including ischemic strokes and intracranial hemorrhages). The study is registered, NCT 00059306. Mean participant age was 63 years; after 1 year mean systolic BP was 138 mm Hg (95% CI 137 to 139) in the higher group and 127 mm Hg (95% CI, 126 to 128) in the lower group. At last study visit, the difference in systolic BP between groups averaged 11 mm Hg (±SD 16). The annualized rate of recurrent stroke in the higher target group was 2.77% (n=152) compared with 2.25% (n=125) in the lower target group (HR 0.81, 95% CI 0.64, 1.03, p-value 0.08). Similar trends were observed for reductions in disabling/fatal stroke (HR 0.81, 95%CI 0.53, 1.23, p-value 0.32) and in the composite outcome of stroke, myocardial infarct or vascular death (HR 0.84, 95%CI 0.68,1.01, p-value 0.10). Intracerebral hemorrhage was reduced by 63% in those assigned to the lower target group (HR 0.37 95% CI, 0.14, 0.89, p-value 0.03). Serious complications of BP lowering were in frequent, and not significantly different in frequency between groups. In patients with recent lacunar stroke, targeting asystolic BP of< 130 mm Hg did not significantly reduce all stroke, but markedly reduced intracerebral hemorrhage. The lower target was safe and well tolerated.